January 11, 2000
Contrary to widespread belief among doctors and patients, patients who get through a major operation that removes the head of the pancreas, part of the small intestine and part of the bile ducts report a surprisingly high quality of life, a Johns Hopkins study shows.
Responding to mailed surveys, patients who underwent a so-called "Whipple" procedure graded their physical, psychological and social well-being at an average 79 to 81 out of a possible 100 percent. These scores are not far behind average responses reported by a group of healthy controls, at 83 to 86. Also known as a pancreaticoduodenectomy, the operation is the most commonly performed operation for pancreatic cancer, although it can be done in only a minority of patients.
"The prevailing belief among some physicians is that patients' quality of life following the procedure is so poor that we almost shouldn't bother doing it," says Charles J. Yeo, M.D., an author of the report and professor of surgery and oncology at Hopkins. "This study -- the largest to assess these patients' quality of life following surgery -- tells us quite the opposite. Whipple survivors had near normal quality of life scores. In addition, 97 percent of patients reported they were able to resume their regular daily activities after the procedure."
Results of the study, supported by the National Institutes of Health, were presented recently at the annual meeting of the Southern Surgical Association in Hot Springs, Va.
Researchers mailed surveys to pancreaticoduodenectomy survivors who had been operated on at Hopkins between 1981 and 1997. The questionnaire was broken down into sections (domains) that looked at physical abilities, psychological issues and social issues; an additional section evaluated functional capabilities and disabilities. Scores were reported as a percentile, with 100 percent being the highest possible score. The same questionnaire was then sent to a group of healthy individuals and a group of patients who had laparoscopic gallbladder removal. (Gallbladder removal also is part of the Whipple operation.)
Responses were tallied from 188 Whipple survivors, 37 laparoscopic gallbladder surgery patients and 31 healthy individuals. Whipple survivors on average rated their physical quality of life a 79, compared with an 83 among laparoscopic surgery patients and an 86 among healthy people. For psychological issues, Whipple survivors rated their quality of life to be a 79, compared with an 82 for laparoscopic surgery patients and an 83 among healthy people. Looking at social issues, Whipple survivors ranked their quality of life at an 81, compared with an 84 among laparoscopic surgery patients and an 83 among healthy individuals.
Whipple survivors also commonly reported thirst, frequent urination, fatigue, foul-smelling stools and diabetes.
The study's other authors were John J. Huang, M.D.; John L. Cameron, M.D.; Taylor A. Sohn, M.D.; Patricia Sauter, R.N.; JoAnn Coleman, R.N.; and Keith D. Lillemoe, M.D. Related Links:
Johns Hopkins Medical Institutions Pancreas Cancer Home Page:
National Cancer Institute: